Providence Health & Services Research Claims Specialist PSJH in California
Providence St. Joseph Health is calling a Research Claims Specialist PSJH to our location in Portland, Oregon or any state within the Providence footprint (AK, WA, OR, CA, NM, NV, TX).
We are seeking a Research Claims Specialist PSJH who will support the Clinical Research billing and account review needs of the Providence Health System. This position reports to the Research Claims Manager and includes collaboration with several research entities within Providence. Main responsibilities include, but not limited to, the review of charges, processing and tracking of on-going research related clinical billing, and regular review of research related billing process for accuracy and compliance. Must uphold the standards of confidentiality, attendance and punctuality.
In this position you will:
Review Epic claims processing reports to compare charges against coverage analysis breakdown of Routine Care and Investigational Service delineation. Coordinates splitting of charges between Research and Insurance (Routine Care). Transfer charges between guarantors as appropriate.
Add appropriate research related Q modifiers, diagnosis codes, NCT and IDE information, as required by Medicare for research patients.
High-level analysis for claims processing to compare against determination of budget breakdown of SOC and investigational service delineation.
Work with Office of Research Administration finance staff to track missing claims and edit services for allocation to research or primary payor. Resolves incorrect billing and ensures refunds are made, if required.
Maintain quality assurance controls for accuracy, completeness, and confidentiality of research data.
Support clinical research billing compliance through the detailed review of clinical trial study calendars and coverage analysis in the clinical trial management system against hospital and professional billing for investigational devices, services, diagnostic procedures, hospitalizations, and all other aspects of patient care.
Work with budget specialists and research coordinators to reconcile billing for research and routine care services with clinical trial agreements and billing matrices. Ensures actual billings for services match coverage analysis and informed consent documents.
Establish and promote positive working relationships within the department, throughout the Providence Health System and between other institutions involved in clinical research.
Address Providers and Research staff billing questions as it relates to pre-determined study budgets and procedures designation.
Prepare and deliver informal training and instruction on Research Claims Review processes as necessary to the greater Providence organization.
Assist in drafting revisions and updates to organizational policies and procedures pertaining to Research Claims Review in conjunction with compliance and federal regulations.
Participate and/or assist in special projects, and performs associated administrative duties, as assigned; may provide functional direction to lower level staff on assigned work.
Required qualifications this position include:
- 2 years experience in research billing and coding, or closely related experience
Preferred qualifications for this position include:
Associate's Degree in Healthcare Administration or related field or 2 additional years of related experience
Bachelor's Degree in Healthcare Administration or related field or 4 additional years of experience
About the ministry you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Claims
Other Location(s): Nevada, California, New Mexico, Oregon, Washington, Texas, Alaska
Req ID: 301458